Keywords
1. Brazilian prison health
2. Disease notification trends
3. Inmate morbidity
4. Prison healthcare integration
5. Health surveillance in prisons
In the shadow of Brazil’s iconic landscapes and vibrant culture lies a less picturesque reality, the health struggles within its prison system. A study published in BMJ Open, arising from an array of national databases, has exposed the worrying trend of rising health morbidity among inmates in Brazilian prisons. This article delves into the intricate details of the study, its methodology, findings, subsequent recommendations, and the wider context of prison health concerns in Brazil.
Methodology
The study, entitled “Health morbidity in Brazilian prisons: a time trends study from national databases,” was conducted with an aim to examine surveillance data about mandatory reporting diseases in prisons. It used secondary data obtained from health units in prisons across the nation, spanning from 2007 to 2014. The data was sourced from several systems, including the National System of Disease Notification (SINAN), Mortality Information System (SIM), and Prison Registration Systems (INFOPEN and GEO prisons).
A significant finding emerged from the study, which notified 23,235 cases of compulsory disease causing morbidity within the prison units, with a higher incidence among men than women. Reflecting on the broader demographic trend, the proportion of prisoners per inhabitant surged from 1.92 in 2007 to 2.77 in 2014.
Disease Notifications
The study showcased that among the notified diseases, tuberculosis stood out with 64.4%, followed by dengue at 9.1%, AIDS at 9.0%, and viral hepatitis at 5.9%. These numbers underline the pronounced susceptibility of prison populations to communicable diseases, which may be exacerbated by overcrowding and inadequate healthcare.
Twelve out of 27 states exhibited an uptick in disease notifications, 14 states showcased stability, and only one state registered a decline. This increase raised questions about the effectiveness and reach of prison healthcare services.
Integration of Prison Health Services
The authors of the study stressed the necessity for prison health services to be integrated into the nation’s regional and national health and justice systems. For many years, the prison health system has operated in isolation, casting inmates into the margins of public health strategies and responses.
Proposed Solutions
To face these challenges, it is necessary to adhere to international recommendations such as the United Nations Standard Minimum Rules for the Treatment of Prisoners, also known as the Nelson Mandela Rules. Good governance for prison health, as proposed by the WHO’s policy brief, is imperative, just as it emphasized proper health organization in prisons.
The study’s authors suggest a need for comprehensive healthcare reforms focusing on health protection and promotion, disease prevention, and treatment complemented by rehabilitative services. They recommend a multidisciplinary approach to address the biopsychosocial factors affecting inmate health.
Recommendation for Prison Healthcare Reform
Healthcare reform that truly transforms the health of criminal justice-involved individuals, as proposed by Rich JD et al., ought to be implemented. The Brazilian Interministerial Ordinance no. 1 from 2014, which established the National Policy of Comprehensive Health Care for People Deprived of Liberty in the Prison System (PNAISP), is a step in the right direction, intended to integrate prison healthcare into the national Unified Health System (SUS).
International Context and Considerations
The Brazilian case is far from unique. Health in prisons has been an ongoing concern in many countries. Studies highlight the high prevalence of diseases such as HIV, tuberculosis, and hepatitis among incarcerated populations in diverse settings, including Brazil and other parts of the world.
Access to HIV and TB prevention and treatment in prisons, as explored in the studies by Telisinghe et al., remains a significant problem that warrants international attention. This is critically aligned with the fulfillment of human rights asserted by entities like Health and Human Rights.
Human Rights Perspective
There is a consensus among human rights advocates that the standard of health services in prison should approximate the wider society’s standards. The right to health and equitable access to healthcare services, as described in the WHO’s health in prison guide, is applicable to all, including inmates.
Implications and Conclusion
The study conducted by Neto FF et al., DOI: 10.1136/bmjopen-2018-026853, is a pivotal piece in understanding the complexities and necessities of prison health in Brazil. It has contributed to bringing to the fore the critical need for structural changes and the integration of prison healthcare systems into broader public health frameworks.
Given the multifaceted challenges in combating diseases within closed environments like prisons, taking a page out of successful international models and adapting them to Brazil’s unique context could serve as a beacon for revamping the existing system.
With this study’s insights, policymakers, public health officials, and prison administrators are better equipped to strategize improvements in prison healthcare provision in Brazil. In optimizing these health services, Brazil could demonstrate a commitment to upholding the dignity and rights of all its citizens, not least those incarcerated.
References
1. Neto FF, Miranda RB, Coelho RA, et al. Health morbidity in Brazilian prisons: a time trends study from national databases. BMJ Open 2019; 9:e026853. doi: 10.1136/bmjopen-2018-026853.
2. United Nations. United Nations Standard Minimum Rules for the Treatment of Prisoners (the Nelson Mandela Rules). Available: https://www.unodc.org/documents/justice-and-prison-reform/Brochure_on_the_UN_SMRs.pdf.
3. WHO. Good governance for prison health in the 21st century. Available: http://www.euro.who.int/__data/assets/pdf_file/0017/231506/Good-governance-for-prison-health-in-the-21st-century.pdf.
4. Rich JD, Chandler R, Williams BA, et al. How health care reform can transform the health of criminal justice-involved individuals. Health Aff (Millwood). 2014;33(3):462-467. doi:10.1377/hlthaff.2013.1133.
5. Brasil. Portaria Interministerial n. 1, de 02 de janeiro de 2014. Available: http://bvsms.saude.gov.br/bvs/saudelegis/gm/2014/pri0001_02_01_2014.html.
6. Møller L, Stöver H, Jürgens R, et al. Health in prisons: a WHO guide to the essentials in prison health. Available: http://www.who.int/hiv/topics/idu/prisons/e90174.pdf.
DOI: 10.1136/bmjopen-2018-026853